feasibility study of the transshield embolic protection system

Conditions: Aortic Stenosis

Summary: the objective of this study is to evaluate the initial safety and performance of the transshield eps used for embolic protection during transcatheter aortic valve replacement (tavr).

patients 18 years of age and older, with severe aortic valve stenosis scheduled for a transcatheter aortic valve replacement (tavr) procedure will be screened to determine eligibility and interest in the study. patients who pass pre-screen eligibility criteria and are willing to participate in the study will be asked to sign the study informed consent form before any study-specific tests or procedures are performed or for any study specific evaluations not considered standard of care that need to be performed to assess eligibility. all subjects enrolled in the study will be followed from baseline through post procedure, prior to discharge and conclude with a 30-day followup visit. the investigator will perform the percutaneous tavr using a commercial tavr system according to their institution's standard practice. after completion of the procedure, the transshield eps filter will be collected and shipped to an independent core lab for histopathology assessment of the embolic debris captured in the filter. post procedure treatment and safety monitoring shall be completed per the investigator's standard guidelines and patients discharged when clinically stable, at the investigator's discretion. prior to discharge, functional status, physical exam/vital signs, medications, safety assessment and hospital stay information shall be collected. patients will be asked to return to the investigational site 30 days post procedure for functional status, physical exam/vital signs, medications, and safety assessment. if the patient is not able to return to the investigational site, the visit may be completed via a tele-health visit with the investigator in combination with an in-office visit to the patient's local general practitioner (gp) or cardiologist. this visit will conclude the patient's participation in the study.

Eligibility criteria:
inclusion criteria: 1. patient is ≥18 years old 2. patient is scheduled for percutaneous tavr using a commercial tavr system 3. patient meets indications for tavr per the device ifu 4. the diameter of the artery at the site of the filter placement is ≤ 42 mm 5. size and condition of the femoral artery iliac arteries are appropriate for the 10f transshield introducer 6. patient, or authorized representative, signs a written informed consent form to participate in the study, prior to any study mandated procedures 7. patient is willing and able to complete follow-up requirement exclusion criteria: 1. patient not undergoing tavr via the trans-femoral route 2. carotid artery stenosis \> 70% in either carotid artery 3. severe vascular tortuosity or anatomy that would preclude the safe introduction of the device 4. aortic valve is a congenital unicuspid valve or is non-calcified 5. predominant aortic regurgitation \>3+ 6. a known contraindication or hypersensitivity to all anticoagulation regimens or an inability to undergo anticoagulation for the study procedure 7. history of bleeding diathesis or in whom anticoagulant and/or anti- platelet therapy is contraindicated, patients who will refuse transfusion, or have an active peptic ulcer or upper gi bleeding within the prior 3 months 8. renal disease requiring chronic dialysis at time of treatment 9. history of stroke or transient ischemic attack (tia) within prior 6 months 10. evidence of an acute myocardial infarction (mi) within 30 days prior to study procedure 11. hemodynamic or respiratory instability requiring inotropic support, mechanical ventilation, or mechanical heart assistance within prior 30 days 12. severe left ventricular (lv) dysfunction with lv ejection fraction (lvef) \<20% 13. severe pulmonary hypertension and right ventricular (rv) dysfunction 14. echocardiographic evidence of intracardiac mass, thrombus or vegetation 15. life expectancy \<12 months due to non-cardiac co-morbid conditions 16. evidence of active systemic or local groin infection 17. significant aortic disease, including abdominal aortic or thoracic aneurysm defined as maximal luminal diameter 5cm or greater; marked tortuosity (hyperacute bend), aortic arch atheroma or severe atheroma (especially with calcification and surface irregularities) of the thoracic aorta, severe "unfolding" and tortuosity of the thoracic aorta 18. known hypersensitivity or contraindication to aspirin, heparin or bivalirudin, ticlopidine, or clopidogrel, and/or contrast agents, that cannot be managed with premedication 19. planned other cardiac surgical procedure within 2 weeks prior to or planned cardiac surgical or interventional procedure within 30 days after the tavr procedure. note: diagnostic cardiac catheterization is permitted within 10 days prior to the tavr procedure 20. known allergy to any device component 21. known or suspected to be pregnant or lactating 22. currently enrolled in an investigational drug or device clinical study in which the primary endpoint has not occurred 23. patient has other medical, social or psychological problem that in the opinion of the investigator precludes them from participating

Keywords: aortic stenosis